The objective of this grant is to study the potential use of acoustic features of the newborn infant cry in the identification of the infant at risk for later developmental delay. Since acoustic cry features are mediated by neurophysiological mechanisms, cry analysis could provide a non-invasive assessment of the nervous system that can be used to identify possible CNS dysfunction. Crying also affects infant outcome as mediated by the caregiving environment. Thus, another aim of this study is to determine these indirect effects of the cry. The nature of the cry sound and the amount of crying are expected to affect how parents perceive the cry, which in turn affects their caregiving of the infant and the infant's later outcome. This biosocial model of infant cry will be studied in 160 infants, 40 term and 40 preterms in each of three groups. The preterms are all 33 weeks gestation, 1.5 kilograms, and include groups of healthy, sick, and sick plus CNS disease infants. Half of the infants will be from low SES families and half will be from middle SES families. The cry is recorded during the neonatal period. Maternal perception of the cry is studied with the Cry Characteristics Questionnaire, the amount of crying at home is recorded, and the Infant Characteristics Questionnaire is administered at 1 and 9 months. The caregiving environment is measured at 9 months and infant cognitive, mental and motor development at 18 months. Acoustic cry features that measure respiratory, neural, and vocal tract aspects of physiological functioning are extracted by computer and used to predict 18-month outcome scores. These features are also used along with the amount of crying at home to predict maternal perception of the cry. Paths of optimal and non-optimal caretaking are posited to derive from maternal cry perception and affect later outcome. This study will test the cry as a potential screening tool to determine which at-risk infants are headed for handicap and show how crying influences the caretaking environment.